Policy and Medicine, February 25, 2016

In politics it is sometimes noted that death does not necessarily prevent you from voting, in the case of Open Payments it doesn’t stop you from being reported on either.

On Tuesday, February 16, 2016, the Centers for Medicare & Medicaid Services (CMS) hosted the first webinar in a series of webinars on the Open Payments program. Upcoming question and answer sessions have been announced via the Open Payments listserv and will be listed on the Open Payments website as they get closer.

At the outset of the question and answer session, the Open Payments team presented a PowerPoint going over the system enhancements for the year. While the PowerPoint presentation will not be made public, the Open Payments team recommended visiting the 2015 Open Payments Overview and Enhancement resource online.

2016 Timeline

This year, in order to be included in the June refresh, changes must be made prior to March 31, 2016. One Q&A attendee was concerned that reporting is supposed to be completed 90 days within January 1 of each year, which usually lands the deadline on March 31. This year, however, is a leap year, messing up conventional wisdom a bit. According to CMS, this year, companies who must report payments have an extra day to do so – the deadline is still March 31, 2016.

The final timeline for 2016 should be coming out relatively soon.

Trending Help Desk Questions

Before getting into individual questions of Q&A Session attendees, the Open Payments team went through some of the trending help questions. Questions such as what happens when it has been over 180 days you last logged into the CMS Enterprise Portal and your account has been deactivated? Or how do you remove a user role in the Open Payment system? Both of those questions can be answered in real time by members of the Open Payments Help Desk.

Another frequently asked question is what steps must be taken before one can complete submission? One of the important things is that if this is the first reporting year for Open Payments for you, you must register your entity. On the other hand, if you have submitted data before, you must complete recertification before taking any action in the system for 2015, and the officer role must be complete in order to be recertified. It is important to note that while providing contact information in the recertification process, do not hit the “enter” key, as it could cause an error code.

Guidance Documents

Several questions focused on guidance documents. One person wondered if there was a new error code guide. There is, and it can be found here. Another wondered if there is an updated Open Payments 2015 System Enhancement Document. It can be found here.

Additionally, the current listing of teaching hospitals can be found here.

Reporting Requirements

Retired Physicians

According to the Open Payments team, physician retirement status doesn’t matter when it comes to the required reporting of payments or ownership interests. The definition of physician as applicable is found in the Social Security Act, and is essentially defined as one who is legally authorized to practice medicine. Therefore, as long as the retired physician can still practice medicine if they so choose, their ownership interest should be reported.

Deceased Physicians

Generally, there is no exclusion for deceased physicians. Payments should be reported as usual.

Cash and In-Kind Items Reporting

At least one attendee was concerned about a manufacturer who has provided both a cash payment and a supply for free products to a covered recipient, under the same research agreement. Since you cannot report both cash and in-kind items in a single report, you would need to report them as two or more separate payments.

Reporting Form Templates

Once concern voiced was if a manufacturer is submitting data for the 2013 or 2014 program year, can they use the current reporting form. The answer is yes, the templates that are posted online should be used for all payment years – 2013, 2014, and 2015. Additionally, the edits that are now in place for this reporting year are effective to any new reports that should have been made in previous years. The template you use depends on which type of payment records you are submitting.

Old, Unreported Payments

If you discover payments that were not previously reported, you may submit payments for prior program years. When doing so, make sure that you submit the payment under the correct program year.

Physicians Being Rejected for Not Being on Validated Physician List

There are evidently a number of specialists who are not currently on the VPL, were accepted in prior years, and are now being rejected. This could be in part to “enhanced system matching logic,” by CMS. Only physicians who are covered recipients under the program final rule will be accepted into the system. As such, certain specialties and physicians no longer match, possibly because CMS determined that they are not considered to be a covered recipient for purposes of Open Payments. If you believe that payments should be reported, CMS suggests that you attempt to submit them. If they do not match, and you cannot make appropriate adjustments to make them match, CMS recommends that you delete the records and do not resubmit them. CMS keeps record of deleted statements and will analyze all deleted statements later.

Taxonomies

Several attendees were curious as to whether or not taxonomies are drivers or if they can singly determine whether or not a recipient is a covered recipient. CMS assured everyone that taxonomies are not drivers for determining whether someone is a covered recipient – that determination is made based on definitions found in the Final Rule. CMS also informed us that the taxonomies are based on a list – or several lists – that might actually be out of date. (Surprise, surprise. Transparency leads to miscommunication and misunderstanding yet again.)

Unmatched Data

If you find that you have unmatched transactions, go back and make sure everything is accurate. According to CMS, the majority of unmatched transactions last year were because of one single mistake. They suggest that you use the Validated Physician List to avoid problems. As a last resort, you can delete the payment from the system, as you will have to have all payments in attested status for reporting to be completed.

Dispute Process

If someone initiates a dispute, you will receive an email notification. You can also monitor disputes under the “Review and Dispute” tab when you’re logged into the system.

There is no change to the dispute resolution process itself, the only change is your company’s contact information being displayed to covered recipients, who can then reach out to you directly.

Deleted Transactions

If a company deletes some of their transactions, they will then be unable to view them in the system. If you delete a record that was already attested to, you will have to re-attest to the deletion before it can be removed.

Published on Policy and Medicine, by Thomas Sullivan, February 17, 2016